INTESTINE Vol.18 No.3(1-2)


特集名 今,変わるのか? 大腸微小病変の取り扱い
題名 [総論](2) 微小腫瘍性病変の内視鏡診断と治療
発刊年月 2014年 05月
著者 岡 志郎 広島大学病院内視鏡診療科
著者 田中 信治 広島大学病院内視鏡診療科
著者 中土井 鋼一 広島大学病院消化器・代謝内科
著者 朝山 直樹 広島大学病院消化器・代謝内科
著者 鴫田 賢次郎 広島大学病院消化器・代謝内科
著者 林 奈那 広島大学病院消化器・代謝内科
著者 西山 宗希 広島大学病院消化器・代謝内科
著者 寺﨑 元美 広島大学病院消化器・代謝内科
著者 茶山 一彰 広島大学病院消化器・代謝内科
【 要旨 】 径5mm以下の大腸微小腫瘍性病変は,通常観察のみで腺腫と癌の鑑別が困難なことが多く,色素観察あるいは拡大観察による表面微細構造の観察が重要である.微小腺腫に関しては,隆起型病変は経過観察も容認されるが,平坦陥凹型病変は内視鏡的摘除の適応である.また,癌あるいは癌を疑う場合には正常粘膜を含めた内視鏡的粘膜切除術による一括切除が原則である.Resect and Discard trialやcold biopsyの適応に関しては,今後のエビデンス集積が必要である.
Theme Can we change to treat for diminutive colorectal polyp ?
Title Endoscopic diagnosis and treatment for diminutive colorectal tumors
Author Shiro Oka Department of Endoscopy, Hiroshima University Hospital
Author Shinji Tanaka Department of Endoscopy, Hiroshima University Hospital
Author Koichi Nakadoi Department of Gastroenterology and Metabolism, Hiroshima University Hospital
Author Naoki Asayama Department of Gastroenterology and Metabolism, Hiroshima University Hospital
Author Kenjiro Shigita Department of Gastroenterology and Metabolism, Hiroshima University Hospital
Author Nana Hayashi Department of Gastroenterology and Metabolism, Hiroshima University Hospital
Author Soki Nishiyama Department of Gastroenterology and Metabolism, Hiroshima University Hospital
Author Motomi Terasaki Department of Gastroenterology and Metabolism, Hiroshima University Hospital
Author Kazuaki Chayama Department of Gastroenterology and Metabolism, Hiroshima University Hospital
[ Summary ] The vast majority of diminutive (- 5 mm) colorectal tumors exhibit a of a very low prevalence of advanced neoplasia. A predict-resect-and-discard policy has recently been proposed in western countries. The histology of some diminutive colorectal lesions reveals carcinomas but not adenomas, however the frequency is relatively low. Clarifying the endoscopic features of diminutive colorectal carcinomas (CRC) with submucosal invasion during colonoscopy is important to manage diminutive lesions. It is also important to confirm depressed areas on the tumor surface using indigocarmine dye spraying and to do magnifying observation when diminutive colorectal carcinoma is suspected. Our data showed that all cases of diminutive CRC were completely resected with en bloc endoscopic resection (ER) after magnifying observation. There were no cases of lymph node metastasis. Therefore, diminutive submucosal invasive CRC with submucosal invasion is thought to be an indication for ER to perform excisional biopsies. Further studies of the Japanese population are required to introduce the use of cold biopsies, cold snare polypectomies, or to implement the predict-resect-and-discard policy for diminutive colorectal lesions in this country.
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